Provider Demographics
NPI:1992443170
Name:JOHNSON, STEPHANIE RENEE
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:HASSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:37205 OLD HIGHWAY 270
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-9206
Mailing Address - Country:US
Mailing Address - Phone:405-380-2642
Mailing Address - Fax:
Practice Address - Street 1:1605 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4022
Practice Address - Country:US
Practice Address - Phone:405-481-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional